Spontaneous bacterial peritonitis in adult patients with primary nephrotic syndrome.

Susceptibility to bacterial infection is a common problem in nephrotic patients. Spontaneous bacterial peritonitis, although characteristic of nephrotic children, is extremely rare in adults.A retrospective review was performed on all adult patients with the discharge diagnoses of primary nephrotic syndrome and spontaneous bacterial peritonitis treated between 1986 and 1998 at Chang Gung Memorial Hospital in Kaohsiung, Taiwan. Ten patients were included in this study, 9 of them men and one woman. The average age was 30.5 years.All the patients had signs of active nephrosis and presented with diffuse abdominal pain, ascites, fever and/or chills. Thirty percent (3/10) of the causative pathogens were gram-positive bacteria and 60% (6/10) were gram-negative bacteria. One patient had sterile cultures. Seven patients recovered after antibiotic treatment for 1 to 2 weeks. Three patients died of septic shock.Therefore, to improve patient outcome, it is essential to establish a diagnosis early and to initiate broad-spectrum antimicrobial therapy even before culture results are available.